Treatment of the Stenoses of the Renal Arteries at the Time of the Aortic Surgery

Abstract

the literature. The aim of this study was to determine the role of aneurysmal volume on the consumption coagulopathy (CC) observed after the endovascular treatment of aortic aneurysms (EVAR). Materials and Methods: Between January 2010 and December 2013, 189 consecutive patients were operated by endovascular techniques for an aortic aneurysm in a single center. We excluded the patients admitted for rupture (9 cases) or a chronic dissection (4 cases), those under long course anticoagulation (21 cases) and two patients with chronic hemopathy. Among patients included, the measurement of aneurysmal volume was carried out in a semi-automated way using the post-processing Aquarius software. Platelet and leucocytes counts, C reactive protein (CRP) level, and prothrombin rate (PR), were obtained the day before intervention then repeated in postoperative throughout the hospital stay. The biological profile was supplemented by the dosage of fibrinogen, factor V and D-dimers in the presence in case of postoperative PR and platelet count falling down. Results: A total of 153 patients (144 men and 9 women) were included. Mean age of patients was 75 years ± 8.7 (range: 54-90). The average duration of the procedure of aneurysmal exclusion was 148 ± 92 min (range: 50-690). Implanted devices were standard abdominal stentgrafts in 120 cases, isolated thoracic in nine cases and fenestrated or branched stentgrafts for complex aneurysms in 24 cases. The average total aneurysmal volume was 197 ± 108 mm (range: 81-611). The percentage of patients presenting a biological CC was 5.2% (8/153) including four cases with exteriorized hemorrhages. Aneurysmal volume was positively correlated with postoperative platelet count fall (P<0.0001), PR falling down (P1⁄40.007), a rise in the leucocyte count (P1⁄40.02) and with the thermal peak. There was no correlation between aneurysmal volume and the rise in postoperative CRP (P1⁄40.40). Mortality at 30 days was significantly higher in the presence of a CC [50% (4/8) vs 0.9% (1/105); P<0.0001]. Conclusion: Aneurysmal volume seems correlated with CCwhich remains strongly associated with themortality after endovascular exclusion of aneurysms, suggesting the need for more aggressive targeted perioperative measures.